System and method for transvascularly stimulating contents of the carotid sheath

Abstract

Methods and systems are disclosed for stimulating contents of the carotid sheath using an intravascular pulse generator and lead. The lead carries an energy delivery device such as an electrode, which is anchor within the portion of the internal jugular vein that is disposed within the carotid sheath. The energy delivery device is energized to transvenously direct energy to target contents of the carotid sheath external to the internal jugular vein. Such target contents may include nervous system elements associated with the carotid sinus baroreceptors, the carotid sinus nerve and associated nerve branches, and or the vagus nerve and associated nerve branches. The system may be used to control blood pressure and/or to lower heart rate and may be suitable for treatment of hypertension, heart failure, or other conditions.

1. A method for stimulating contents of the carotid sheath, comprising:
 intravascularly advancing an energy delivery element into an internal jugular vein; 
 retaining the energy delivery element in a portion of the internal jugular vein contained within a carotid sheath; 
 positioning a shield at least partially surrounding the carotid sinus sheath, and 
 energizing the energy delivery element to transvenously direct energy to target contents of the carotid sheath external to the internal jugular vein wherein the shield blocks conduction of energy beyond the sheath during energization of the energy delivery implant. 
 
     
     
       2. The method of  claim 1 , wherein energy is directed to a carotid artery within the carotid sinus sheath. 
     
     
       3. The method of  claim 1  wherein energy is directed to a carotid sinus nerve or nerve branch within the carotid sinus sheath. 
     
     
       4. The method of  claim 1  wherein energy is directed to a vagus nerve or nerve branch within the carotid sinus sheath. 
     
     
       5. The method of  claim 1  wherein energy is directed to nerve branches emanating from carotid artery baroreceptors. 
     
     
       6. The method of  claim 1 , further including intravascularly advancing a second energy delivery element into a second internal jugular vein;
 retaining the second energy delivery element in a portion of the second internal jugular vein contained within a second carotid sheath; and 
 energizing the second energy delivery element to direct energy to contents of the second carotid sheath external to the second internal jugular vein; 
 retaining the neurostimulation implant within the first blood vessel; and 
 positioning at least one electrode within the patient, the electrode in communication with the neurostimulation implant, and 
 stimulating the nervous system target using the electrode. 
 
     
     
       7. The method of  claim 1  wherein the energy is electrical energy. 
     
     
       8. The method of  claim 1  wherein the energy is ultrasound energy. 
     
     
       9. A method for stimulating contents of the carotid sheath, comprising:
 intravascularly advancing an energy delivery element into an internal jugular vein; 
 retaining the energy delivery element in a portion of the internal jugular vein contained within a carotid sheath; 
 using a medical device, delivering an insulative material into extravascular space adjacent to the internal jugular vein, the insulative material defining a channel within the extravascular space, and 
 energizing the energy delivery element to transvenously direct energy to target contents of the carotid sheath external to the internal jugular vein, wherein said energizing causes energy to conduct along the channel to the target contents. 
 
     
     
       10. The method of  claim 9  wherein the material includes a fat. 
     
     
       11. The method of  claim 9  wherein the material includes silicone. 
     
     
       12. An intravascular system for stimulation of contents of a carotid sheath, the system comprising:
 a pulse generator positionable within a blood vessel; 
 a lead coupled to the pulse generator; 
 an anchor adapted to anchor the lead in a portion of an internal jugular vein disposed in a carotid sinus sheath; 
 a plurality of electrodes disposed on the lead, the electrodes including a first array and a second array, wherein the first and second arrays are positioned such that when the first array is positioned in the internal jugular vein to direct stimulation energy transvascularly to a vagus nerve in the carotid sheath, the second array is positioned to direct stimulation energy transvascularly towards a carotid artery or carotid sinus nerve within the carotid sheath; and 
 a shield positionable at least partially surrounding the carotid sheath, the shield configured to block transmission of stimulation energy to tissues external to the carotid sheath. 
 
     
     
       13. The system of  claim 12 , wherein the first and second arrays are independently energizable by the pulse generator. 
     
     
       14. The system of  claim 12  wherein the first and second arrays are simultaneously energizable by the pulse generator.